Final N300 Spinal Cord Injury

Front 1

What does tetraplegia mean?

Back 1

injury that affects all 4 limbs *legs and arms*

Front 2

Instead of the word tetraplegia, the USA uses?

Back 2

quadraplegia

Front 3

Paraplegia means what?
What are the 2 types?

Back 3

Loss of function in lower extremities
Complete-loss of all function at level all the way down
Parially-nerve level from injury down is partially affected
**males more affected, ages 16-30

Front 4

What are the most common causes of spinal cord injuries?

Back 4

Car accidents
falls
violence
sports

Front 5

What are the first vertebrae to last?

Back 5

1st-cervical disk, rests on 2nd-damage at this level is extremely serious
2nd-cervical
12 thoracic
5 lumbar
sacrum
coccyx

Front 6

What functions a spinal cord injury pt has depends on?

Back 6

The level of injury
The nerves that are truly involved is what actually kind of injury a pt has, not the bone structure.

Front 7

An injury at C1-C8 has what type of injury and considered what?

Back 7

Tetraplegia- none or impaired use of arms and legs

Front 8

What injury does a pt have if it occurs T1-S2?

Back 8

Paraplegia- complete use of arms, none/impaired use of legs

Front 9

If an injury is at S1-S5, what is impaired?

Back 9

Impaired bowel/bladder and sex function

Front 10

If a pt has an injury about C4, usually on?

Back 10

ventillator, cant use arms hands

Front 11

If injury is at C5?

Back 11

Deltoid/biceps can be used now

Front 12

If injury is at C7?

Back 12

Pt can use triceps-arms dont flop

Front 13

C8-T1, here a pt can have hands back, so they can?

Back 13

push their own wheelchair

Front 14

If they have C6 wrist extensors, they can?

Back 14

grab things

Front 15

a complete injury vs incomplete means?

Back 15

Total vs partial loss of muscle control and sensation below level of injury

Front 16

What would you use the spinal dermatones for?

Back 16

where dr. truly measures functional ability- sensations and motor function
EXACT true level of injury

Front 17

If a pt has a cauda equina injury, what will be the results?

Back 17

only the nerves from S1 to S5 are damaged.
Bowel
Bladder
Sex dysfunction ONLY
NO motor deficts

Front 18

Anterior cord syndrome usually leads to ?

Back 18

Front of cord is damaged.
Impaired ability to sense pain
Temp/touch lost below level of injury
Complete paralysis below injury
May preserve pressure and joint sensation
MOST COMMON W/FLEXION INJURIES

Front 19

What is central cord syndrome?

Back 19

Damage to center of spinal cord. More paraylsis in arms than legs-tough.
May preserve bowel/bladder
Most common in : hyperextension, spinal stenosis.

Front 20

What is Brown-sequard syndrome?
How might someone get it?

Back 20

damage is on 1side of spinal cord.
Impaired loss/movement to innjured side, but can usually feel pain and temperature
Opposite side: normal movement, pain and temperature sensations impaired.
How? gunshot wound, stabbing, T bone accident

Front 21

What is posterior cord syndrome?

Back 21

Damage to back of spinal cord.
Good muscle power, pain, and temperature sensation
Problems with coordination of movements
Motor weakeness below level of injury

Front 22

What are the most common assessment findings of spinal cord injury pts?

Back 22

1. pt will have low BP!!! (60/40, 90/60) This is ok.
2. Bradycardia
3.Dependent edema cause they do not have the muscle tone to bring back the fluid ** when they are supine, fluid is absorbed*
4. Neuropathic pain
5. temperature intolerance -cant constrict and dialate
6. weakened and impaired cough
7. rounded ABD, quad belly-lost muscle tone
8. spasticity- in muscles

Front 23

TEMPERATURE intolerance is a huge problem in spinal cord injury pts. Why?

Back 23

SCI pts loose ability to sweat, shiver, vasodilate or vasoconstrict.
If room is cold, they are cold, room is warm, they are warm.
They are at constant risk for hypo or hyperthermia!

Front 24

What are the s/s of a Spinal cord injury pt experiencing hyperthermia?

Back 24

HA
Confusion
nasal congestion

Front 25

What can we do for our hyperthermia pt?

Back 25

cold wet towel, wrapped around the back of the neck
Ice to groin and axilla
Skin should be damped down to allow water to evaporate (like sweat)
Loosen clothing

Front 26

What are the s/s we would see in our spinal cord injury pt experiencing hypothermia?

Back 26

Shivering above level of injury, discolored skin, HA, decreased level of conciousness.
More clothes
blankets, down comforters, flannel sheets
*External heat sources- be careful-- risk for burns is high, so heating pads and blankets is not recommended

Front 27

If pt has spinal cord injury at C3-C5, what is affected respiratory wise?

Back 27

Diaphragm-inspiration

Front 28

If pt has spinal cord injury at C2-C3, C5-C8 what is affected respiratory wise?

Back 28

Accessory muscles -inspiration

Front 29

If pt has spinal cord injury at T1-T7, what is affected respiratory wise?

Back 29

Intercostal muscles-inspiration, expiration

Front 30

If pt has spinal cord injury at T7-T12, what is affected respiratory wise?

Back 30

Abdominals -coughing

Front 31

A weak/absent diaphragm/intercostals= at risk for?

Back 31

hypoventillation

Front 32

Weak or absent abdominal muscles =?

Back 32

impaired cough

Front 33

What is the number one mortality reason of spinal cord injury pts?

Back 33

pulmonary complications

Front 34

What are the respiration complications seen in spinal cord pts?

Back 34

Pneumonia, atelectaisis, PE

Front 35

Most pts that have a spinal cord injury need what to bring up secretions?

Back 35

Quad cough-like a himlick maneuveur.
Let pt take several deep breaths, place hand below ziphoid process, and forcefully press up and function as a diagphram.
3deep breaths, inhale, then thrust hands up

Front 36

When do spasms and spacicity in spinal cord injury?

Back 36

May not occur til weeks, days, months after, or not at all.

Front 37

What is going on when a pt has spasms/spacicity?
What does a pt think this is?

Back 37

After injury, pt goes into spinal shock.
Complete loss of neuro function, pt is flaccid.
When it wears off, spacicity may come back. Pt think it is a recovery.
Neurons are starting to wake up, but arent functioning

Front 38

A spinal cord injury blocks? causing the body to?

Back 38

Blocks inhibitory signals, body overreacts to stimuli, causing spasm.
If you have a quick stretch, UTI, impaction, infection, pressure ulcer, pain-all cause body to overreact (noxious stimuli)
Spasms can be very helpful for transfering, coordinating.
Also can be dangerous, and hit ppl.

Front 39

How can we help spinal cord injury pts with spasm/spacicity?

Back 39

Stretching
ROM
Standing
Proning-lay on stomach
Medications-Baclofen, Tizanidine, Valium
Look for skin breakdown

Front 40

Baclafen and tazanodine should not be?

Back 40

not be abruptly stopped
Backlofen-hallucinations, seizures
taz-high BP, arrythmias

Front 41

What are the benefits to spasticity?

Back 41

maintains muscle bulk
warning sign of infection/painful stimuli
Increased circulation (decrease DVT risk)
May assist with transfers or walking

Front 42

What is skin breakdown/tissue death from?

Back 42

from tissues not receiving blood supply(hypoxia)

Front 43

Why must we be really careful skin wise with spinal cord injury pts?

Back 43

messages from nerve cells in skin no longer signal discomfort/pain

Front 44

How do we prevent skin breakdown spinal cord injury pts?

Back 44

weight shifts EVERY 15 MINUTES
in wheelchair turn q2-3 hours
skin checks
proper bed surface
SMOKING CESSATION
weight control/nutrition

Front 45

What is the most essential part/area for a spinal cord injury pt?

Back 45

skin-we must educate

Front 46

What if a spinal cord injury pt develops a stage 3 or 4 wound and cant even get up to the wheelchair anymore?

Back 46

Probably get surgical debridement
use wound vac for couple of months
get flap surgery
put on a special bed for 6-8 weeks on clinitron bed, maybe months.

Front 47

S2- S4 controls?

Back 47

bladder function and external spincter

Front 48

T10 to T 12 controls?

Back 48

Internal spincter

Front 49

Over distended bladder and high pressures can cause what?

Back 49

kidney damage

Front 50

Spinal cord injury pts usually have an annual cycscostopy when they come in for Dr. checkup, why?

Back 50

to look at bladder and fuction

Front 51

Pts on intermittent caths can?

Back 51

reuse them after they wash them out
"clean catheters"

Front 52

What is our bladder goal for spinal cord injury pts?

Back 52

keep bladder less than 400 cc
cath every 4-6 hours (different if drinking more, etc)

Front 53

What are common complications bladder wise in SCI pts?

Back 53

Autonomic dysreflexia
Stones
UTI
bladder cancer

Front 54

The S2 to S4 controls?

Back 54

Bowel spincter and ability to sense fullness, decreases peristalsis

Front 55

What is our bowel goal for SCI pts and how?

Back 55

Bowel program!
Diet-fiber
Meds-stool softener or metamucil
Timing, frequency
techniques, equipment
goal-get them on a pattern.

Front 56

What are the common problems seen in sci pts regarding bowels?

Back 56

constipation
incontinence
hemmorrhoids
ileus- decreased parastalsis, obstruction

Front 57

The syndrome characterized by an abrupt onset of an excessively high blood pressure cuased by uncontrolled sympathetic nervous system respone in persons with spinal cord injury?

Back 57

Autonomic dysreflexia*** medical emergency

Front 58

What spinal cord injury pts are at most risk for autonomic dysreflexia?

Back 58

T7 level and above

Front 59

Why does autonomic dyreflexia occur?

Back 59

Noxious stimuli Pain stimuli sent up spinal cord
Attempts to send to brain, but doesnt make it
Sympathetic nervous system activated
Causes severe vasocontriction in legs and ABD and below injury in response
Vasoconstriction causes BP to rise
Basoreceptors (carotid arteries, etc) tells brain BP is way too high
brain slows does heart rate, vasodilation all above level of injury
Messages about and below dont communicate, and BP continues to rise

Front 60

What are the s/s of autonomic dysreflexia?

Back 60

High increase in BP
Normal: 90/60, Autonomic dysreflexia 130/80!
They arent at risk for stroke or heart attack here yet.
Sweating-above injury
feeling that "something isnt right"
Flushed , warm on top
Cool, pale on bottom
Goosebumps
Vision changes
Jitters
Anxiety
Headache-worse HA of life
Tighness felt in chest

Front 61

What are the common causes of Autonomic dysreflexia?

Back 61

BLADDER***90%**
stones, distention, catheter, surgery, UTI
Bowel 8%
Full bowel
Constipation
hemorrhoids
Gallstones/ulcers
Colonoscopy
Skin-
Pressure ulcers, ingrown toenails, lying on something, surgical inscisions, burns
Other-tight restricive clothing, cramps, labor, sex

Front 62

Cathing the pt is good to prevent autonomic dyreflexia, but remember?

Back 62

Only release 1000 cc at most at a time, so body can adjust

Front 63

Lets say we think pt is having autonomic dysreflexia-what do we do!!!??

Back 63

1. RAISE HOB 90 DEGREES, LOWER LEGS
2. check kink in catheter, ask pt what triggers for AD are
3. loosen clothes
4. check urinary drainage system, clogs? change?
Check ingrown toenail, broken bone, burn
Continue to check blood pressure q5min!

Front 64

What must we do if pt is having autonomic dysreflexia and we want to check the bowel?

Back 64

use lidocane jelly to numb rectum before checking (decrease stimuli)

Front 65

If symptoms of autonomic dysrefleia persist and you cannot find what is causing it, and BP continues to rise, do what?

Back 65

careful- give nifedipine 10mg to bring it down-- we want to avoid this really b/c pt can bottom out
If pt bottoms out on this, put pt with head down.
(BP goes over 150 systolic-notify MD)